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The pupa, cephalic capsule and antenna of the recently described Eupithecia gypsophilata Skou, Mironov & Rietz, 2017 are detailed from exuviae obtained ex larvae from Madrid and Saragossa (central Spain).

The reed bunting is a passerine bird of the Palearctic region, some subspecies suffer a decline in their populations. Four species of lice have been cited in reed bunting, but lice studies have not been carried out in the Iberian Peninsula. Between 2018 and 2020 a wintering population of the reed bunting is sampled in the center of the Iberian Peninsula through mist nets. Lice were collected directly from birds by a visual body examination. Of the 208 reed buntings sampled, only four individuals were parasitized. We find two species: Menacanthus chrysophaeus, which is the first record in Iberian lice, and Brueelia blagovescenskyi. Lice are not associated with the sex or age of the birds. The prevalence obtained is low compared to other European populations. This difference can be explained by the phenology of the subspecies, the migratory populations have a lower load of lice than sedentary populations.

Resumen En 2014 se da la primera aparición en Asturias de Vespa velutina Lepeletier, 1836 var. nigrithorax du Buysson, 1905, en Asturias, especie exótica invasora procedente de Asia. Desde entonces los apicultores hacen frente a esta invasión, siendo el sector agrario más afectado. Recientemente, en febrero de 2018, se ha aprobado el Plan de Acción provincial y ya se están tomando medidas de control. En este estudio se recogen datos referentes a la V. velutina, tanto experimentales como bibliográficos, para elaborar un informe preliminar de la situación actual de la invasión en el Principado de Asturias. El principal objetivo es ampliar nuestros conocimientos sobre la biología y ecología de este himenóptero para poder actuar adecuadamente. Se observa una estrecha relación entre la temperatura y el desarrollo del avispón, pudiendo las reinas de este prolongar o acortar su hibernación en función de las temperaturas. Se analizan en este artículo diferentes factores para el desarrollo de la V. velutina: cercanía a cursos de agua dulce y posibles plantas atrayentes. Así mismo, supone un riesgo para otras especies de insectos autóctonos, tales como la abeja (Apis mellifera L. 1758) y el avispón europeo (Vespa crabro L. 1758). Con los datos de nidos es evidente el incremento poblacional en los últimos años. Abstra ct The first sighting of Vespa velutina Lepeletier, 1836 var. nigrithorax du Buysson, 1905, in Spain took place in 2010 in Navarra (Castro & Pagola-Car te, 2010). In 2014 came the first appearance in Asturias. It is an invasive exotic species from Asia. Since then, beekeepers in Asturias face this invasion, being the worst affected agricultural sector. Recently, in February 2018, the Provincial Action Plan was approved and measures are already being taken. This study includes both experimental and bibliographical data on V. velutina, with the intention of producing a preliminary report on the current situation of the invasion in the Principality of Asturias. There is little information regarding the behavior of this species in our ecosystems. The main objective: to broaden our knowledge of the biology and ecology of this hymenopteran in order to be able to act appropriately. There is a close relationship between temperature and the development of the Asian hornet. The worst affected municipalities in Asturias so fare are Llanes, Valdés and Gijón (Figura 15). The high adaptability of queens is very remarkable, and if the optimal climatic conditions are not present, they can even extend the hibernation period (Figura 10). Different factors for involved in the distribution of V. velutina are analyzed in this article, like proximity to freshwater courses and possible attractive plants. Based on the data obtained (Figura 11), in northern Spain queens in the spring seems to have a preference for citrus, garden plants and other fruit trees, and will be found in areas close to rivers, streams and springs. The species also poses a risk to other native insect species, such as the honey bee (Apis mellifera L., 1758) and the European hornet (Vespa crabro L., 1758). Trap data show a higher number of captures of V. velutina (both queens and workers) than V. crabro. Since these are non-selective traps for the genus Vespa, it is suspected that the population of the invasive hornet is outnumbering the population of the native hornet. The population growth of the Asian hornet in the last year has increased considerably, as evidenced by the increase in the number of nests in 2018 compared to 2017. Secondary nests are found mostly in trees ranging from 2 to 20 meters (Figura 16). This is a real threat; quick and effective action is urgent. Trapping work is essential, it is recommended that queen trapping should be done in spring and the trapping of workers should be carried out throughout the summer. The removal of nests is carried out through the entire season, depending on the sightings, the sooner a nest is eliminated the less the hornet´s population will grow. In 2017 a larger number of captured specimens was taken in traps placed near nests that had not been removed (Figura 14), so improvements are necessary both in the position of the traps and in the elimination of nests. More scientific research is needed in order to control the species.

This paper describes a journey to Iceland and Greenland in August 2019, and exposes the impressions made in two weeks of visits along the Southern coast of Greenland. The trip was carried out on board a ship of the Norwegian company Hurtigruten named Roald Amundsen, which set sail from the port of Reykjavik and, after crossing the Strait of Denmark, arrived at Umivik Bay, on the south-eastern coast of Greenland. Over the next twelve days, the ship toured the southern fjords and bays of this immense island of Danish sovereignty, such as the Skjoldungen or the Prins Christian Sound, or human settlements such as Aappilattoq, Qaqortoq, Qassiarsuk, Igaliku, Ivittuut, Nuuk, the capital and main city of the territory, Kapisillit and Maniitsoq, to finish sailing through one of the longest Greenlandic fjords, the Kangerlussuaq Fjord or Søndre Strømfjord, at the bottom of which is located the international airport of Kangerlussuaq, where the authors took the plane back to Denmark. From an environmental point of view, Greenland is a vulnerable territory, climate change is seen on this border more clearly than in other places on the planet: retreating glaciers, changes in the relief, increasing temperatures, etc. Likewise, the authors present the sensations that, as naturalists, landscapes, flora, fauna and other such unique experiences caused them. En este trabajo se relata el viaje de los autores a Islandia y Groenlandia, en agosto de 2019, y se exponen las impresiones causadas en dos semanas de visitas por la costa meridional de Groenlandia. El viaje se realizó a bordo de un barco de la compañía noruega Hurtigruten denominado Roald Amundsen, que zarpó del puerto de Reikiavik y, tras cruzar el Estrecho de Dinamarca, llegó a la bahía de Umivik, en la costa sudoriental de Groenlandia. A lo largo de los siguientes doce días, el barco recorrió los fiordos y bahías del sur de esta inmensa isla de soberanía danesa, como el Skjoldungen o el Prins Christian Sound , o asentamientos humanos como Aappilattoq, Qaqortoq, Qassiarsuk, Igaliku, Ivittuut, la capital del territorio Nuuk, Kapisillit y Maniitsoq, para terminar navegando por uno de los más largos fiordos groenlandeses, el Kangerlussuaq Fjord o Søndre Strømfjord, al fondo del cual está el aeropuerto internacional de Kangerlussuaq, donde los autores tomaron el avión de regreso a Dinamarca. Desde el punto de vista ambiental, Groenlandia es un territorio vulnerable, el cambio climático se aprecia en esta frontera con más nitidez que en otros lugares del planeta: glaciares en retroceso, cambios en el relieve, aumento de la temperatura, etc. Asimismo, los autores exponen las sensaciones que, como naturalistas, les causaron los paisajes, la flora, la fauna y otras experiencias tan singulares.

The first sighting of Vespa velutina Lepeletier, 1836 var. nigrithorax du Buysson, 1905, in Spain took place in 2010 in Navarra (Castro & Pagola-Carte, 2010). In 2014 came the first appearance in Asturias. It is an invasive exotic species from Asia. Since then, beekeepers in Asturias face this invasion, being the worst affected agricultural sector. Recently, in February 2018, the Provincial Action Plan was approved and measures are already being taken. This study includes both experimental and bibliographical data on V. velutina, with the intention of producing a preliminary report on the current situation of the invasion in the Principality of Asturias. There is little information regarding the behavior of this species in our ecosystems. The main objective: to broaden our knowledge of the biology and ecology of this hymenopteran in order to be able to act appropriately. There is a close relationship between temperature and the development of the Asian hornet. The worst affected municipalities in Asturias so are are Llanes, Valdés and Gijón (Figura 15). The high adaptability of queens is very remarkable, and if the optimal climatic conditions are not present, they can even extend the hibernation period (Figura 10). Different factors for involved in the distribution of V. velutina are analyzed in this article, like proximity to freshwater courses and possible attractive plants. Based on the data obtained (Figura 11), in northern Spain En 2014 se da la primera aparición en Asturias de Vespa velutina Lepeletier, 1836 var. nigrithorax du Buysson, 1905, en Asturias, especie exótica invasora procedente de Asia. Desde entonces los apicultores hacen frente a esta invasión, siendo el sector agrario más afectado.Recientemente, en febrero de 2018, se ha aprobado el Plan de Acción provincial y ya se están tomando medidas de control. En este estudio se recogen datos referentes a la V. velutina, tanto experimentales como bibliográficos, para elaborar un informe preliminar de la situación actual de la invasión en el Principado de Asturias. El principal objetivo es ampliar nuestros conocimientos sobre la biología y ecología de este himenóptero para poder actuar adecuadamente. Se observa una estrecha relación entre la temperatura y el desarrollo del avispón, pudiendo las reinas de este prolongar o acortar su hibernación en función de las temperaturas. Se analizan en este artículo diferentes factores para el desarrollo de la V. velutina: cercanía a cursos de agua dulce y posibles plantas atrayentes. Así mismo, supone un riesgo para otras especies de insectos autóctonos, tales como la abeja (Apis mellifera L. 1758) y el avispón europeo (Vespa crabro L. 1758). Con los datos de nidos es evidente el incremento poblacional en los últimos años.

Purpose Efficient management of COPD represents an international challenge. Effective management strategies within the means of limited health care budgets are urgently required. This analysis aimed to evaluate the cost-effectiveness of a home-based disease management (DM) intervention vs usual management (UM) in patients from the COPD Patient Management European Trial (COMET). Methods Cost-effectiveness was evaluated in 319 intention-to-treat patients over 12 months in COMET. The analysis captured unplanned all-cause hospitalization days, mortality, and quality-adjusted life expectancy. Costs were evaluated from a National Health Service perspective for France, Germany, and Spain, and in a pooled analysis, and were expressed in 2015 Euros (EUR). Quality of life was assessed using the 15D health-related quality-of-life instrument and mapped to utility scores. Results Home-based DM was associated with improved mortality and quality-adjusted life expectancy. DM and UM were associated with equivalent direct costs (DM reduced costs by EUR -37 per patient per year) in the pooled analysis. DM was associated with lower costs in France (EUR -806 per patient per year) and Spain (EUR -51 per patient per year), but higher costs in Germany (EUR 391 per patient per year). Evaluation of cost per death avoided and cost per quality-adjusted life year (QALY) gained showed that DM was dominant (more QALYs and cost saving) in France and Spain, and cost-effective in Germany vs UM. Nonparametric bootstrapping analysis, assuming a willingness-to-pay threshold of EUR 20,000 per QALY gained, indicated that the probability of home-based DM being cost-effective vs UM was 87.7% in France, 81.5% in Spain, and 75.9% in Germany. Conclusion Home-based DM improved clinical outcomes at equivalent cost vs UM in France and Spain, and in the pooled analysis. DM was cost-effective in Germany with an incremental cost-effectiveness ratio of EUR 2,541 per QALY gained. The COMET home-based DM intervention could represent an attractive alternative to UM for European health care payers.

This work is aimed to evaluate the nutritional composition, and the techno-functional and in vitro physiological properties of flours made using six different insect species and the sensorial feasibility of including them in bakery products. The insect flours exhibited high protein and fat contents as their main components, highlighting the presence of chitin in ant samples. The techno-functional properties showed high oil holding, swelling, and emulsifying capacities in all the analysed insect flours, whereas their bulk density, hydration properties, and foaming capacity showed average values and no gelation capacity. Moreover, these edible insect flours exhibited effective hyperglycaemia and hyperlipidaemia properties, which together with their high antioxidant capacity are associated with beneficial in vitro physiological effects. The beetle and caterpillar flours stand out in these properties, and thus were selected to make a cupcake. The sensory evaluation confirmed that the edible beetle powder can be successfully included in baked goods to provide excellent sensory properties and very high acceptance. Thus, these insect flours may be of great interest to the food industry as a healthy source of protein, exerting a positive impact on functional and sensory food properties, and with a potential role in the prevention of diseases associated with hyperglycaemia and hyperlipidaemia., The Universidad Autónoma de Madrid supported this work through a grant from the Faculty of Sciences (academic year 2019/20). M. Rebollo-Hernanz received funding from the Ministry of Universities FPU program for his pre-doctoral fellowship (FPU15/04238). M. A. Martín-Cabrejas thanks to the Excellence Line for University Teaching Staff within the Multiannual Agreement between the Community of Madrid and the UAM (2019–2023).

Data are provided on the biology, phenology, oviposition and morphology (first to final instars) as well as the chaetotaxy L2, L5 of the larentine moth Nebula ibericata (Staudinger, 1871) in Madrid, central Spain.

The study aimed to assess the preferences of expert physicians about the requirements for inhalation devices for patients with chronic obstructive pulmonary disease (COPD) and to identify the most relevant advantages and disadvantages to their prescription. In a two-round Delphi survey, 96 Spanish COPD-expert pulmonologists completed an internet-based questionnaire to evaluate the degree of importance of the characteristics of the inhaler devices in their choice for COPD. The requirements needed for use in COPD were that the device permits a high pulmonary deposit of the drug, allowed its dispensation at low inspiratory flows, did not require hand-mouth coordination, generated an exact and reproducible dose, its operation was easy to teach, provided the perception of a correct inhalation, had an intuitive use mechanism and security mechanisms to prevent overdosing and generates a reduced oropharyngeal deposit (very good consensus). Modulite®, Respimat® and NEXThaler® were associated with high pulmonary deposit, and Respimat® showed correct dispensation at low inspiratory flows. All dry-powder inhaler devices were associated with the advantage of not requiring coordination, and Respimat® was the only device considered as difficult to teach by more than 50% of the experts. Breezhaler® and Genuair® were positively associated with patients' awareness of correct inhalation, whereas Spiromax® stood out for its intuitive use mechanism. In conclusion, our study contributes to defining the inhaler device properties required for their use in patients with COPD, and to identify the devices that, in the opinion of experts, best meet each requirement.

Fossilized remains preserved in amber provide abundant data on the paleobiota surrounding the resin-producing plants, but relatively scarcer information about the resinous sources themselves. Here, dark pseudoinclusions in kidney-shaped amber pieces from the Early Cretaceous (Albian) amber from Spain are studied. This type of fossilized remain, abundant in Cretaceous ambers, was first interpreted as fossilized vacuole-bearing microorganisms, but later regarded as artifactual and probably secreted by the resinous trees, although their origin remained unclear. Using complementary microscopy (light, electron, confocal), spectroscopy (infrared, micro-Raman), mass spectrometry and elemental analysis techniques, we demonstrate that the pseudoinclusions correspond to droplets of phloem sap containing amber spheroids and preserving both organic and inorganic residues consistent with degraded components from the original sap. The amber pieces containing pseudoinclusions are fossilized, resin-in-sap-in-resin double emulsions, showing banding patterns with differential content of resin-in-sap emulsion droplets. Our findings represent the first time fossilized phloem sap, 105 million years old, has been recognized and characterized, and open new lines of paleontological research with taxonomic, taphonomic, physiological and ecological implications.

The objective of this study was to evaluate the nutritional composition, techno-functional, and in vitro physiological properties of flours from six different insect species (mealworm, beetle, caterpillar, ant, locust, and cricket). The chemical composition of insects was evaluated following the standard methods (AOAC). Bulk density, water holding capacity, oil holding capacity, water absorption capacity, swelling capacity, emulsifying activity, foaming capacity, and gelation capacity were measured. In vitro antioxidant capacity was measured by the direct ABTS method. Hypoglycemic (glucose adsorption and the inhibition of α-amylase, glucose diffusion, and starch hydrolysis) and hypolipidemic (cholesterol and bile salts binding and lipase inhibition capacities) were investigated using in vitro methods. Insect flours exhibited a high content of protein (39.4%–58.1%) and fat (17.7%–50.1%) as main components, although the presence of chitin in ant samples was also highlighted. The techno-functional properties showed high oil holding, swelling, and emulsifying capacities in all insect flours analyzed, besides bulk density, hydration properties, and foaming capacity showing average values and no gelation capacity. Insects showed high antioxidant capacity (179–221 mg Trolox equivalents/g). Moreover, these edible insect flours revealed effective hyperglycemic and hyperlipidemic properties. Insect flours inhibited α-amylase activity (47.1%–98.0%) and retarded glucose diffusion (17.2%–29.6%) and starch hydrolysis (18.2%–88.1%). Likewise, they bound cholesterol and bile salts (8.4%–98.6%) and inhibited lipase activity (8.9%–47.1%). Hence, these insect flours might be of great interest to the food industry, being a healthy source of protein, exerting a positive impact on functional food properties, and potentially preventing the development of diseases associated with hyperglycemia and hyperlipidemia.

Low plasma level of alpha1-antitrypsin (AAT) is an established risk factor for early-onset chronic obstructive lung disease (COPD). However, less attention is given to the levels of AAT in the general population.This is a part of a multicentre, population-based study conducted at 11 sites throughout Spain. Plasma levels of AAT were available for 837 persons with a mean (SD) age of 58.05 (11.3) years: 328-smokers, 272-ex-smokers and 237 non-smokers. Out of 837, 303 (36.2%) had a diagnosis of COPD, 222 (26.5%) had respiratory symptoms but no COPD, and 312 (37.3%) were healthy controls.In the whole cohort, the mean level of plasma AAT was 1.51 (0.47)g/L. Levels were higher in COPD patients [1.55 (0.45)g/L] and individuals with respiratory symptoms [1.57 (0.47)g/L] than in controls [1.43 (0.47)g/L], p0.001, a finding which persisted after correction for age and CRP. Plasma AAT levels were negatively associated with FEV1/FVC ratio, after adjustment for age, sex, smoking status, CRP, TNFα, fibrinogen and albumin. The risk for COPD was significantly associated with higher AAT levels in univariate and multivariate models, with odds ratios of 1.8 and 1.5, respectively. In the univariate and multivariate models smoking status, gender, and CRP levels were also associated with COPD probability, demonstrating that they act independently.Increased circulating levels of AAT, similarly to CRP and other markers of systemic inflammation, is an important feature of COPD. Our results highlight a complex interrelationship between levels of AAT and health of respiratory system.

Background This study aimed to identify the relevant factors for the choice of an inhaler device by physicians and the selection of the most important characteristics of a device according to different characteristics of patients with COPD. Method In this two-round Delphi survey, 96 Spanish COPD-expert pulmonologists completed an internet-based, self-administered questionnaire, which consisted of a first part with 19 items related to the prioritization of the drug or the device, the experience, ability and preference of the patient, and the experience and preferences of the healthcare professional. For each item, responses were grouped into three categories based on a 9-point Likert-type scale, calculating the response frequency and the degree of consensus. The second part included 18 items related to the inhalation devices with the aim to identify the main characteristics of a device for 8 different profiles of patients with COPD. Results Experts considered that the selection of a device was relevant when choosing the treatment for COPD patients, although 62.5% of them prioritised the selection of the drug over the device. The experience of the patient (89.6%) and his/her ability to handle the device (97.9%), together with coordination (96.9%), ability to learn (87.5%) and adherence to therapy (84.4%) were the main aspects considered in the selection of inhalation device. The panel identified Respimat® as the most adequate device for patients with either low inspiratory flow or severely impaired lung function and Spiromax® for patients with either impaired fine motor skills or older than 70 years. Conclusions Selection of the inhalation device is recognized by specialists as a strategic therapeutic decision and should be based on the characteristics of the individual patient. Some devices may be more adequate for different patient profiles.

Data are presented on the biology of Casilda consecraria (Staudinger, 1871) from central Spain (Madrid), in addition to original morphological data of the ovum, larva (L1–L2, L4–L5) and pupa. Larval data include 2nd larval instar chaetotaxy. A brief comparison of the biological and morphological characters is made with Rhodometra sacraria (Linnaeus, 1767) which belongs to the same tribe, the Rhodometrini Agenjo, 1952. Additional data are included on larval parasitoids (Hymenoptera: Ichneumonidae; Braconidae).

Introduction: Severe COPD impacts deeply on daily activities and is associated with high hospitalisation rate and poor prognosis. Objective: To investigate the effectiveness of a home-centered disease management program in reducing all-cause hospitalisations in severe COPD. Methods: GOLD III/IV COPD patients with at least 1 exacerbation in the previous year were randomised to disease (DM) or usual (UM) management. DM intervention included self-management coaching (“Living Well With COPD”) and decision support in case of clinical worsening over about 1 year. Results: 319 patients (74.3% on HOT, 27.3% on HMV) entered follow-up (Intention-To-Treat, ITT). Difference in yearly number of unscheduled all-cause hospital days (primary outcome) was -5,32 days [95%CI -13,69; 3,05](DM 17.4±35.4, UM 22.6±41.8, p=0.161 , Wilcoxon, ITT). It was -7.99 days [95%CI -16.62; 0.64], p=0.070 ) in Per Protocol (PP, eligibility criteria not fulfilled and/or having received p=0.074 ) in ITT and -8.26 ([95%CI -16.39; -0.12], p=0.047 ) in PP. No between-group differences were found in health status (SGRQ total score). More patients died in UM (n=23) than in DM (n=3, p ), mainly from respiratory cause (16 patients). Conclusions: This 1-yr intervention in severe COPD showed a non-statistically significant reduction of all-cause hospital days (those including nursing facility). Significant reductions in acute care hospital days (PP) and a lower number of deaths were shown with DM.

KING G. E., VIEJOMONTESINOS J. L. 2012. Keiferia dalibori sp. nov. (Insecta: Lepidoptera; Gelechiidae) a new species from Chile. Acta zool. cracov., 55(1): 59-64. Abstract. Keiferia dalibori sp. nov. is described from south-central Chile it being the first species in the genus Keiferia BUSCK, 1939 recognised from that country. Data are provided for the male imago, the female remaining undescribed.

Resumen Introduccion Aunque asma y EPOC son enfermedades distintas, muchos pacientes comparten caracteristicas de ambas entidades. Estos casos pueden tener una evolucion y una respuesta al tratamiento diferente. Sin embargo, la evidencia disponible es escasa, y es necesario valorar si representan un fenotipo diferencial y aportar recomendaciones sobre su diagnostico y tratamiento, ademas de identificar posibles lagunas de conocimiento. Metodo Consenso nacional de expertos en EPOC en dos etapas: 1) Se establecieron los bloques tematicos a tratar y se elaboro una primera propuesta de aseveraciones, mediante una reunion presencial con metodologia de «tormenta de ideas» estructurada. 2) Se realizaron dos rondas de consenso via correo electronico, utilizando una escala tipo Likert. Resultados Se consensua la existencia de un fenotipo clinico diferencial denominado «fenotipo mixto EPOC-asma», cuyo diagnostico se realizara si se cumplen 2 criterios mayores o uno mayor y 2 menores (criterios mayores: prueba broncodilatadora muy positiva [aumento del FEV 1 ≥ 15% y ≥ 400 ml], eosinofilia en esputo y antecedentes personales de asma; criterios menores: IgE total elevada, antecedentes personales de atopia y prueba broncodilatadora positiva [aumento del FEV 1 ≥ 12% y ≥ 200 ml] en dos o mas ocasiones). Se recomienda el uso precoz de corticoides inhalados (CI) ajustados individualmente, ser cautos con la retirada brusca de CI y, en casos graves, valorar el uso de la triple terapia. Finalmente, queda patente la falta de estudios especificos sobre la historia natural y el tratamiento de estos pacientes. Conclusiones Es preciso profundizar en el conocimiento de este fenotipo para establecer pautas y recomendaciones adecuadas para su diagnostico y tratamiento.

Introduction Although asthma and COPD are different pathologies, many patients share characteristics from both entities. These cases can have different evolutions and responses to treatment. Nevertheless, the evidence available is limited, and it is necessary to evaluate whether they represent a differential phenotype and provide recommendations about diagnosis and treatment, in addition to identifying possible gaps in our understanding of asthma and COPD. Methods A nation-wide consensus of experts in COPD in two stages: (1) during an initial meeting, the topics to be dealt with were established and a first draft of statement was elaborated with a structured “brainstorming” method; (2) consensus was reached with two rounds of e-mails, using a Likert-type scale. Results Consensus was reached about the existence of a differential clinical phenotype known as “Overlap Phenotype COPD–Asthma”, whose diagnosis is made when 2 major criteria and 2 minor criteria are met. The major criteria include very positive bronchodilator test (increase in FEV 1 ≥15% and ≥400 ml), eosinophilia in sputum and personal history of asthma. Minor criteria include high total IgE, personal history of atopy and positive bronchodilator test (increase in FEV 1 ≥12% and ≥200 ml) on two or more occasions. The early use of individually adjusted inhaled corticosteroids is recommended, and caution must be taken with their abrupt withdrawal. Meanwhile, in severe cases the use of triple therapy should be evaluated. Finally, there is an obvious lack of specific studies about the natural history and the treatment of these patients. Conclusions It is necessary to expand our knowledge about this phenotype in order to establish adequate guidelines and recommendations for its diagnosis and treatment.

Resumen El conocimiento de los profesionales y la destreza de los pacientes en el uso de los dispositivos inhalados continua siendo deficiente. Objetivo Validacion externa por un grupo de expertos de unas recomendaciones clinicas practicas elaboradas para la mejora del conocimiento y del uso de la terapia inhalada. Metodos Tras una revision bibliografica sobre terapia inhalada se propusieron 40 recomendaciones clinicas. Se utilizo el metodo Delphi modificado en dos rondas para contrastar las opiniones de un panel de 59 expertos sobre dichas recomendaciones. Estas estaban agrupadas en 8 areas: aspectos generales (4), farmacos inhalados (9), cartucho presurizado y camaras espaciadoras (6), inhaladores de polvo (4), nebulizadores (3), dispositivos para ventilacion mecanica (3), inhaladores para el nino (5) y aspectos relacionados con el cumplimiento y la educacion (6). Resultados Tras la primera ronda del panel se aprecio un consenso en la aceptacion de 35 de las 40 recomendaciones analizadas. Al final de la segunda ronda se alcanzo el acuerdo en 39 (97,5%). En 8 (20%) el consenso fue por unanimidad (100%). El item 14 fue suprimido de las recomendaciones al no alcanzarse el consenso. Conclusiones La valoracion externa por expertos en terapia inhalada constato un elevado nivel de acuerdo con las recomendaciones clinicas propuestas. Este consenso proporciona un instrumento que podria contribuir a la mejora futura en el uso de los inhaladores en nuestro ambito.

Background: Studies in many countries in the 1990s revealed deficiencies in physicians' knowledge about inhalation therapy. In an attempt to remedy this situation, Spanish scientific societies implemented a variety of educational strategies. The objective of the present study was to assess changes in attitudes and knowledge about inhalers and inhalation techniques in a sizable sample of physicians. Methods: An 11-question multiple choice test was developed and administered throughout Spain to practicing physicians from specialties that frequently prescribe inhaler devices. The survey collected demographic characteristics (four items), preferences (two items), and issues related to knowledge (three items) and education (two items) about devices and inhalation techniques. Completion of the questionnaire was voluntary, individual, and anonymous. Results: A total of 1514 respondents completed the questionnaire. Dry powder inhalers (DPI) were preferred by 61.2% physicians, but only 46.1% identified "inhale deeply and forcefully'' as the most significant step in the inhalation maneuver using these devices. Only 27.7% stated that they always checked the patient's inhalation technique when prescribing a new inhaler. A composite variable, general inhaled therapy knowledge, which pooled the correct answers related to knowledge, revealed that only 14.2% physicians had an adequate knowledge of inhaled therapy. Multivariate analysis showed that this knowledge was lowest among internal medicine and primary care physicians. Conclusions: Prescribers' knowledge of inhalers and inhalation techniques remains poor in Spain. The causes should be identified in further research to allow effective educational strategies to be developed. Specific educational policies should be addressed to general practitioners.

The EPI-SCAN study (Epidemiologic Study of COPD in Spain), conducted from May 2006 to July 2007, determined that the prevalence of COPD in Spain according to the GOLD criteria was 10.2% of the 40 to 80 years population. Little is known about the current geographical variation of COPD in Spain.We studied the prevalence of COPD, its under-diagnosis and under-treatment, smoking and mortality in the eleven areas participating in EPI-SCAN. COPD was defined as a post-bronchodilator FEV₁/FVC ratio0.70 or as the lower limit of normal (LLN).The ratio of prevalences of COPD among the EPI-SCAN areas was 2.7-fold, with a peak in Asturias (16.9%) and a minimum in Burgos (6.2 %) (P0.05). The prevalence of COPD according to LLN was 5.6% (95% CI 4.9-6.4) and the ratio of COPD prevalence using LLN was 3.1-fold, but with a peak in Madrid-La Princesa (10.1%) and a minimum in Burgos (3.2%) (P0.05). The ranking of prevalences of COPD was not maintained in both sexes or age groups in each area. Variations in under-diagnosis (58.6% to 72.8%) and under-treatment by areas (24.1% to 72.5%) were substantial (P0.05). The prevalence of smokers and former smokers, and cumulative exposure as measured by pack-years, and the age structure of each of the areas did not explain much of the variability by geographic areas. Nor is there any relation with mortality rates published by Autonomous Communities.There are significant variations in the distribution of COPD in Spain, either in prevalence or in under-diagnosis and under-treatment.

ResumenAntecedentes El estudio EPI-SCAN (Epidemiologic Study of COPD in Spain), realizado entre mayo de 2006 y julio de 2007, ha determinado que la prevalencia de la EPOC en Espana segun los criterios GOLD es del 10,2% (IC95% 9,2–11,1) de la poblacion de 40 a 80 anos. Se desconoce la variabilidad geografica actual de la EPOC en Espana. Objetivos Describir la prevalencia de EPOC, su infradiagnostico e infratratamiento, y los datos de tabaquismo y mortalidad en las once areas participantes en el estudio EPI-SCAN. Se definio EPOC como un cociente FEV1/FVC posbroncodilatador

We aimed to describe changes in the prevalence of chronic obstructive pulmonary disease (COPD) in Spain by means of a repeated cross-sectional design comparing two population-based studies conducted 10 yrs apart. We compared participants from IBERPOC ( Estudio epidemiologico de EPOC en Espana ) (n = 4,030), conducted in 1997, with those of EPI-SCAN (Epidemiologic Study of COPD in Spain) (n = 3,802), conducted in 2007. Poorly reversible airflow obstruction compatible with COPD was defined according to the old European Respiratory Society definitions. COPD prevalence in the population between 40 to 69 yrs of age dropped from 9.1% (95% CI 8.1–10.2%) in 1997 to 4.5% (95% CI 2.4–6.6%), a 50.4% decline. The distribution of COPD prevalence by severity also changed from 38.3% mild, 39.7% moderate and 22.0% severe in 1997, to 85.6% mild, 13.0% moderate and 1.4% severe in 2007, and in the 40–69 yr EPI-SCAN sub-sample to 84.3% mild, 15.0% moderate and 0.7% severe. Overall, underdiagnosis was reduced from 78% to 73% (not a significant difference) and undertreatment from 81% to 54% (p

Puntos clave: – La enfermedad pulmonar obstructiva cronica (EPOC) se caracteriza por la presencia de obstruccion cronica y poco reversible al flujo aereo, que se asocia a una reaccion inflamatoria anomala, principalmente frente al humo del tabaco. – La obstruccion al flujo aereo se define por la espirometria cuando el cociente volumen espiratorio forzado en el primer segundo/capacidad vital forzada (FEV1/FVC) tras broncodilatacion es menor de 0,7 (o por debajo del limite inferior de la normalidad en personas mayores de 60 anos). – La EPOC se asocia a inflamacion cronica con remodelacion que afecta a las vias aereas, parenquima y arterias pulmonares. – La gravedad de la EPOC se clasifica por el valor del FEV1 posbroncodilatador, estando tambien relacionada con la existencia de sintomas, atrapamiento aereo, insuficiencia respiratoria, afectacion sistemica y comorbilidad asociada. – La prevalencia de la EPOC en la poblacion adulta es del 9% en Espana y oscila entre el 8 y el 20% en Latinoamerica. La EPOC representa la cuarta causa de muerte en Espana y en el mundo.

– Chronic obstructive pulmonary disease (COPD) is characterized by chronic airflow limitation that is not fully reversible, associated with an abnormal inflammatory response, principally to tobacco smoke. – Airflow limitation, measured by spirometry after bronchodilation, is defined as a ratio of forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) of less than 0.7 (or below the lower limit of normal in persons over 60 years of age) . – COPD is characterized by chronic inflammation associated with remodeling of the airway, lung parenchyma, and pulmonary arteries. – The severity of COPD is classified on the basis of the postbronchodilator FEV1 value taking into account symptoms, such as air trapping, respiratory insufficiency, systemic involvement, and associated comorbidity. – The estimated prevalence of COPD in the adult Spanish population is 9%, while in Latin America this figure ranges from 8% to 20%. COPD is the fourth leading cause of death in Spain and the world.

To evaluate the reliability of home respiratory polygraphy for the diagnosis of sleep apnea-hypopnea syndrome (SAHS) and to compare the cost of this technique with that of nighttime polysomnography performed in a sleep laboratory.This was a prospective study of a random sample of patients with clinically suspected SAHS in which the participants who underwent both home respiratory polygraphy and nighttime polysomnography were blinded as to the results of their first test. Costs were calculated based on a theoretical population of 1000 individuals. A t test for paired samples, the Pearson correlation coefficient, and a receiver operator characteristic curve were used for the statistical analysis.The study population was composed of 45 patients with a mean (SD) age of 52.3 (11) years of whom 21 (46.6%) were diagnosed with SAHS, defined by an apnea-hypopnea index greater than 10 in nighttime polysomnography. Comparison of the results obtained in both recordings revealed statistically significant correlations for all comparisons. The optimal cutoff in this population was a respiratory disturbance index of 13.7 or more, for which the area under the receiver operating characteristic curve was 87.5% (95% confidence interval, 74.2%-95.4%). The mean cost of home respiratory polygraphy in a patient with suspected SAHS was euro69, whereas that of polysomnography was euro179.Home respiratory polygraphy is a reliable technique for the diagnosis of SAHS. Using this technique routinely in patients suspected of SAHS will be more economical than using nighttime polysomnography. Uncertain results must be verified by nighttime polysomnography.

Objetivos El presente estudio se realizo con los siguientes objetivos: a) valorar la fiabilidad de la poligrafia respiratoria domiciliara (PRD) para el diagnostico de sindrome de apneas-hipopneas durante el sueno (SAHS), y b) comparar los costes derivados de la realizacion de PRD con los de la polisomnografia nocturna (PSG) efectuada en el laboratorio de sueno. Pacientes y metodos Se trata de un estudio prospectivo y ciego. La poblacion de estudio estuvo constituida por una seleccion aleatoria de pacientes con sospecha clinica de SAHS. A todo paciente incluido en el estudio se le realizaron PRD y PSG sin conocer el resultado de la primera. Para el calculo de costes se utilizo una poblacion teorica de 1.000 personas. Para el analisis estadistico se emplearon la prueba de la t de Student para muestras emparejadas, el coeficiente de correlacion de Pearson y el calculo de las curvas de eficacia diagnostica. Resultados Se estudio a 45 pacientes, con una edad media (± desviacion estandar) de 52,3 ± 11 anos, de los que se diagnostico de SAHS (indice de apneas-hipopneas ≥ 10 en la PSG) a 21 (46,6%). Al comparar los valores obtenidos en la PRD y la PSG, las correlaciones fueron significativas para todos los pares relacionados. El punto de corte optimo en nuestra poblacion fue un indice de acontecimientos respiratorios de 13,7 o mayor, con un area bajo la curva de eficacia diagnostica del 87,5% (intervalo de confianza del 95%, 74,2-95,4%). La realizacion de una PRD en un paciente con sospecha de SAHS supone un coste medio de 69 €, mientras que el de una PSG es de 179 €. Conclusiones La PRD es un metodo fiable para el diagnostico de SAHS. Su realizacion de forma protocolizada supone un ahorro respecto a la realizacion de PSG a todos los pacientes con sospecha de SAHS. Por ultimo, los resultados dudosos de la PRD requieren la realizacion de PSG.

Original data are presented which describe ova of the following six taxa in the Sterrhinae Meyrick, 1892: Idaea litigiosaria (Boisduval, 1840), Idaea sericeata calvaria Wehrli, 1927, Idaea ochrata albida (Zerny, 1936), Idaea incisaria (Staudinger, 1892), Idaea cervantaria (Millière, 1869) and Scopula (Glossotrophia) asellaria dentatolineata Wehrli, 1926. Subsequent analysis of SEM imaging provides data related to the chorion structure, as well as that associated with the strategies adopted by females at oviposition under laboratory conditions; comparative data are provided of other European sterrhines, The Sección de Investigación at the Universidad Autónoma de Madrid provided a grant to enable the first-named author to study in Chile in 2010, for which we are most grateful

La gripe aviar esta causada por virus de la gripe tipo A que se presentan de manera natural entre las aves silvestres. La producida por el subtipo H 5 N 1 se esta extendiendo en la actualidad y es motivo de preocupacion porque afecta a humanos, con brotes altamente mortales sobre todo en Vietnam y Tailandia. La transmision del virus de las aves a las personas es muy poco eficiente. El mecanismo de transmission es la via respiratoria por inhalacion de productos procedentes de las aves enfermas. La transmision de persona a persona se ha dado en muy pocos casos y no se ha propagado mas alla de una persona. Hasta el momento se han registrado 252 casos con 148 fallecidos. Los sintomas van desde los tipicos de la gripe –fiebre, tos, dolor de garganta y dolor muscular– hasta la infeccion ocular, neumonia, distres respiratorio y otras complicaciones que pueden producir la muerte del paciente. Todos los pacientes presentan signos clinicos y radiologicos de neumonia, con cambios radiologicos tales como infiltrados difusos y consolidaciones lobulares o segmentarias con broncograma aereo. La mortalidad es elevada. El tratamiento mas activo son los inhibidores de la neuraminidasa; entre ellos, el oseltamivir, que ha sido el mas empleado, consigue reducir la replicacion virica y mejorar la supervivencia. Los casos humanos han coincidido con epidemias en las aves. La gravedad de esta enfermedad justifica un estrecho seguimiento y estudio.

Objetivo En los estudios realizados hasta ahora, el coste de la enfermedad pulmonar obstructiva cronica (EPOC) puede estar sobrestimado porque han incluido a pacientes previamente diagnosticados que consultaron por sus sinto-mas, por lo que la gravedad puede ser superior a la que re-almente tendria una poblacion no seleccionada obtenida de la poblacion general. El proposito del presente estudio fue estimar el coste directo de la EPOC basandose en una mues-tra representativa del conjunto de la poblacion espanola de entre 40 y 69 anos (estudio IBERPOC). Metodo El coste se evaluo retrospectivamente a traves de un cuestionario referido al ultimo ano en los 363 pacien-tes con EPOC del estudio IBERPOC. Un neumologo realizo a todos ellos una espirometria estandarizada en cada una de las 7 areas geograficas en las que se llevo a cabo el estudio. Resultados La asistencia hospitalaria fue el coste mas elevado (41% del coste total), seguido del tratamiento farma-cologico (37%). El coste por paciente fue de 98,39 €, y por paciente previamente diagnosticado, de 909,5 €. El coste de la EPOC grave por persona fue mas de tres veces el coste de la EPOC moderada y mas de 7 veces el coste de la EPOC leve. El coste anual estimado de la EPOC en Espana fue de 238,82 millones de euros (informacion referida a 1997). Conclusiones Este es el primer estudio que estima el coste de la EPOC en una muestra representativa de la poblacion general, que es inferior al calculado por los estudios que han analizado una muestra seleccionada con diagnostico previo de EPOC. La distribucion del gasto no se ajusta a las practi-cas asistenciales recomendables, por lo que son necesarias actuaciones que optimicen los recursos empleados en el se-guimiento y en el tratamiento de la enfermedad, prestando especial atencion a su diagnostico temprano.

The COPD Patient Management European Trial (COMET) investigated the efficacy and safety of a home-based COPD disease management intervention for severe COPD patients.The study was an international open-design clinical trial in COPD patients (forced expiratory volume in 1 s For the 157 (disease management) and 162 (usual management) patients eligible for ITT analyses, all-cause hospitalisation days per year (mean±sd) were 17.4±35.4 and 22.6±41.8, respectively (mean difference −5.3, 95% CI −13.7 to −3.1; p=0.16). The disease management group had fewer per-protocol acute care hospitalisation days per year (p=0.047), a lower BODE index (p=0.01) and a lower mortality rate (1.9% versus 14.2%; pThe COMET disease management intervention did not significantly reduce unplanned all-cause hospitalisation days, but reduced acute care hospitalisation days and mortality in severe COPD patients.

Fundamento El objetivo de este estudio fue investigar las caracteristicas sociodemograficas y de tabaquismo, asi como la presencia de sintomas respiratorios y enfermedad pulmonar obstructiva cronica (EPOC) en cuatro grupos de fumadores: de cigarrillos (FC), de cigarros (FP), de cigarrillos y cigarros (FCP), de cigarros que fueron fumadores de cigarrillos (FPEC) y de cigarrillos que fueron fumadores de cigarros (FCEP). Metodo Estudio epidemiologico multicentrico que incluyo a 4.035 individuos entre 40 y 69 anos; 1.963 no fumadores, y 1.146 fumadores activos. Entre estos ultimos, 869 eran FC, 37 FP, 97 FCP, 86 FPEC y 57 FCEP. Se analizaron sus caracteristicas sociodemograficas y de tabaquismo, asi como los sintomas respiratorios y la presencia de EPOC. Resultados Los FP fueron con mayor frecuencia varones, de clases sociales mas deprimidas (p Conclusiones Los FP son mayoritariamente varones de mas edad que los FC y pertenecen a estratos educacionales deprimidos. Tienen concentraciones bajas de CO en su aire espirado y escaso conocimiento de los riesgos que este habito supone para su salud. Los FPEC tienen mas alta incidencia de sintomas respiratorios y de EPOC que los no fumadores e identica incidencia de EPOC que los FC.